你可知自己孩子的动脉已经老化了吗

Do you know how old your kids' arteries are?

你知道自己孩子的动脉有多老吗？

It's a potentially important question as scientists increasingly uncover links between healthy habits in childhood and risk for heart disease later in life. And there are growing concerns about the cardiovascular health of millions of children in the U.S. who are considered obese or overweight.

这个问题可能很重要，因为科学家们越来越多地发现，人们儿时的健康习惯与日后罹患心脏病的风险之间存在关联。在美国，被视为肥胖或超重的儿童数以百万计，围绕他们心血管健康的担忧正在与日俱增。

A new study suggests there is a simple way to assess a child's arterial health with a calculation based on an often-overlooked component of cholesterol: triglycerides.

一项新的研究表明，有一种评估儿童动脉健康的简便方法，即以甘油三酯──胆固醇中一个常常被忽略掉的成分──为基础来进行计算。

The calculation is the ratio of triglycerides to HDL, or good cholesterol. It can be easily determined from a standard cholesterol blood test. In the study, based on nearly 900 children and young adults, researchers at Cincinnati Children's Hospital Medical Center found that the higher the ratio, the greater the likelihood a child would have stiff and damaged arteries.

这就是要算出甘油三酯与高密度脂蛋白（又名有益胆固醇）的比值，这个数值通过一项常规的胆固醇血检便能轻易得出。该研究共涉及近900名儿童及青少年。辛辛那提儿童医学中心(Cincinnati Children's Hospital Medical Center)的研究人员发现，这个比值越高，儿童动脉硬化或动脉受损的可能性就越大。

'We are demonstrating vascular changes in supposedly healthy adolescents,' said Elaine Urbina, head of preventive cardiology at Cincinnati Children's and lead author of the study. 'Stiff vessels make your heart work harder. It isn't good for you.' The study was published in the journal Pediatrics in April.

图：如何从小预防心血管疾病该研究的首席作者、辛辛那提儿童医学中心预防心脏病学主管伊莱恩•乌尔比纳(Elaine Urbina)说：“我们正在论证那些据称身体健康的青少年的血管变化。血管硬化会加重你的心脏工作负担。这对你并无益处。”这项研究于4月份发表在《儿科学》(Pediatrics)杂志上。

The problem is also called hardening of the arteries. In adults it typically arises from a combination of aging and the cumulative impact of blood pressure, cholesterol and other assaults on the walls of blood vessels over decades of life. It carries heightened risk for heart attacks, strokes and sudden death.

这个问题也被称作动脉硬化。成年人之所以会出现动脉硬化通常是因为身体老化和血压、胆固醇及其他一些血管壁毛病长年累月影响共同作用的结果。而动脉硬化则会使人们罹患心脏病、中风或突然死亡的风险增高。

When it shows up in children, it's a sign of 'accelerated aging,' Dr. Urbina said, and likely raises the risk of dangerous outcomes relatively early in adult life. The good news is that doctors believe health can be restored to young people's arteries with regular physical activity and a healthy diet. This includes cutting back on sugary beverages and foods high in carbohydrates such as potatoes, white rice and pasta.

乌尔比纳博士说，当这个问题出现在儿童身上时，它就是“加速老化”的迹象，它还可能增高人们在青壮年时期罹患重病的风险。好消息是，医生们相信，通过进行常规的身体锻炼及保持健康的饮食，年轻人的动脉便能重获健康。保持健康的饮食包括要少喝含糖饮料、少吃像土豆、白米饭和意大利面这样的高碳水化合物食品。

In late 2011, concern that a generation of children is growing up with already established heart risks prompted federal health officials with the support of the American Academy of Pediatrics to recommend universal cholesterol screening for kids, preferably between ages 9 and 11.

2011年末，出于对一代儿童将会伴随业已形成的心脏病风险成长起来的担忧，联邦健康官员在美国儿科学会(American Academy of Pediatrics)的支持下推介了普遍适用于儿童──最适用于那些年龄在9到11岁间孩子──的胆固醇筛查机制。

Generally, the focus of attention in such tests is LDL, or bad cholesterol, which at high levels has long been associated with increased chances of heart attacks and strokes. A large body of evidence shows that heart risk can be reduced by lowering LDL with one of a class of drugs called statins.

一般来说，这类测试的关注焦点在低密度脂蛋白（又名有害胆固醇）身上。低密度脂蛋白偏高长期以来都与心脏病和中风机率增高息息相关。大量的证据表明，通过服用一类名为斯达汀(statins)的药物降低低密度脂蛋白可以减少心脏病发病风险。

But high triglycerides and low HDL─the other components that are measured in a standard cholesterol blood test─are a hallmark reflection of the poor diets and sedentary lifestyles that researchers say are behind the wide prevalence of obesity among both children and adults. These markers may get less attention because efforts to develop drugs that prevent serious events by manipulating either component have come up short.

但甘油三酯偏高且高密度脂蛋白偏低──后者是另一种在常规胆固醇血检可以测量出的元素──是饮食不良、久坐不动生活方式的一个特征体现。研究人员说，它们是众多儿童和成年人变得肥胖的原因。但这些诱因可能不再那么受人关注，因为人们研发药物的诸多努力成效不大──他们是通过控制其中任一元素来研发那些预防严重疾病的药物的。

Triglycerides amount to an indicator of both fat and sugar in the blood stream. Dr. Urbina describes them to patients as having a backbone of fat with three (tri) sugars (glycerides) attached.

甘油三酯相当于一项能显示出血液中脂肪和糖份含量的指标。乌尔比纳向患者形容说，这就像一根附带了三种糖（甘油脂）的脂肪脊柱。

Other research has linked a high triglyceride-to-HDL ratio to arterial stiffness in adults. Dr. Urbina and her colleagues wondered whether a similar correlation existed in children and young people.

其他的研究已将成年人甘油三酯/高密度脂蛋白比值偏高的情况与动脉硬化联系了起来。乌尔比纳和她的同事想知道，在儿童和青少年身上是否也存在着一种与此相似的关联性。

Participants in the study, who ranged in age from 10 to 26, underwent fasting tests for cholesterol, blood pressure, blood sugar and other heart-risk markers. They also had three different noninvasive tests that measure elasticity in blood vessels.

该研究的参与者年龄在10到26岁之间，他们都做了胆固醇、血压、血糖和其他心脏病风险指标的空腹检查。他们还进行了三项不同的、旨在测量血管弹性的无创检测。

One third of the participants were found to have stiff arteries based on one of the elasticity tests; 13% had abnormalities on two of the tests and 3% had arterial stiffness according to all three tests.

结果发现，有三分之一的参与者在其中一项血管弹性检测中被查出有动脉硬化；13%的人在其中两项检测中被查出指标不正常；有3%的人在经过全部三项检查后被认定为动脉硬化。

The researchers found a 'progressive rise' in both heart-related risk factors and stiff arteries as the triglyceride-to-HDL ratio increased.

研究人员发现，随着甘油三酯/高密度脂蛋白比值增高，心脏病相关的风险因素和动脉硬化状况也均随之“逐步上升”。

The study wasn't large enough or intended to establish when a ratio is 'healthy' or when especially aggressive treatment is called for. That will require additional research. But scientists found that the 378 participants whose ratio was in the highest of three groups had an average ratio of 2.7.

但该研究涉及范围不够广，或者说它并未打算去设立一个标准：即何时一个比值才算得上“健康”或患者什么时候需要实施特别积极的治疗。所以这就需要再进行额外的研究。但科学家们也发现，在三组当中比值最高的378名参与者的平均比值为2.7。

What this shows 'is that being overweight and the cholesterol problems that often accompany it have an important impact on your blood vessels,' said Sarah de Ferranti, director of preventive cardiology at Boston Children's Hospital, who wasn't involved with the study. A direct correlation to damaged blood vessels in kids hadn't previously been shown.

波士顿儿童医院(Boston Children's Hospital)预防心脏病学主管萨拉•德•费伦蒂(Sarah de Ferranti)并未参与上述研究，她说，该研究告诉我们“体重超重和常常与之伴生的胆固醇问题会对你的血管产生重要的影响。”但之前的研究并未表明，儿童体内受损的血管与超重有什么直接的关系。

Dr. de Ferranti, a pediatrician, said that based on the study, 'I would worry more about my patients in the realm' of 2.7 or higher.

儿科医生费伦蒂说，基于这项研究，“我将会更担心我的那些患者中比值等于或高于2.7的人。”

The American Heart Association recommends adults maintain an HDL level of at least 40 milligrams per deciliter of blood (mg/dL) for men and 50 mg/dL for women, and preferably higher. Triglycerides for adults should be below 150 mg/dL, with lower being better. The ratio using these numbers is higher than that found in the study. That is partly because children generally have lower triglyceride levels than those of adults.

美国心脏协会(American Heart Association)建议成年男子将高密度脂蛋白保持在至少40毫克/分升的水平，成年女子则为50毫克/分升，最好比这个数值再高一些。而成年人的甘油三酯水平则应低于150毫克/分升，数值再低些会更好。与该项研究中发现的数字相比，用这些数字算出来的比值会更高，部分原因在于儿童体内的甘油三酯水平一般比成年人更低。

Dr. Urbina sometimes prescribes a prescription form of fish oil for patients with persistently high triglycerides; neither its benefit in children nor long-term impact among adults and children has been determined. Generally doctors are reluctant to give medications to children with the problem. Lifestyle change, including diet and exercise, is the mainstay remedy, although it poses big challenges.

乌尔比纳有时会向甘油三酯居高不下的患者以处方药形式开出鱼油药方。但该药方对儿童是否有所裨益、对成年人和儿童是否会产生长期影响，迄今都尚无定论。一般来说，医生都不太愿意向患有此类疾病的儿童开药。尽管困难重重、充满挑战，但包括饮食和锻炼在内的生活方式的转变才是主要补救办法。

A major strategy for doctors is getting kids to avoid or sharply reduce consumption of sugary beverages, including sodas and sports drinks, big contributors to triglyceride levels.

医生的一个主要策略就是让孩子们不喝或者少喝包括苏打水和运动饮料在内的含糖饮料，这对改善其甘油三酯水平颇有裨益。

'It's incredibly difficult to scale a kid down to the recommended 50 grams of sugar when a juice box has 24,' said Heather Vanderhaar, of suburban Cincinnati. Ms. Vanderhaar's two boys, Benjamin, 12, and Maxwell, 10, have a genetic condition that results in elevated triglyceride levels. They are working with Dr. Urbina to keep those levels under control.

家住辛辛那提郊区的希瑟•范德哈尔(Heather Vanderhaar)说：“一盒果汁就含有24克糖，这种情况下让孩子将饮用量减到推荐的50克，太难了。”范德哈尔太太的两个儿子──12岁的本杰明(Benjamin)和10岁的麦克斯韦(Maxwell)──他们天生的身体条件就会导致甘油三酯水平偏高。为了将体内的甘油三酯水平维持在可控范围内，他们一直在乌尔比纳那儿就医。

'At this point they're maintaining,' Ms. Vanderhaar said. School sports and bike riding are among their physical activities. The boys aren't allowed soda, cookies or junk food. 'We allow them to have treats but in moderation,' she said. 'The thinking is if you start early, you can reverse any damage done to your arteries.'

范德哈尔太太说：“他们目前病情稳定。”学校的运动和自行车骑行都在两兄弟的活动范畴之内。但他们不许喝苏打水、不能吃曲奇或垃圾食品。范德哈尔太太还说：“我们允许他们犒劳自己，但要适量。这么做是基于这样的想法：如果你早点行动，你还能修复动脉已受到的损害。”

Molly and Kate Cassabon, 18-year-old identical twins from Waterville, Ohio, went for two years putting on substantial weight before their problem was diagnosed at age 10 as genetically high triglycerides that exceeded 800 mg/dL. Their grade school installed an automated external defibrillator out of fear that either of the girls could collapse at any moment from a heart attack.

来自俄亥俄州沃特维尔(Waterville, Ohio)的同卵双胞胎姐妹莫莉(Molly)和凯特•卡萨博(Kate Cassabon)在10岁那年被诊断为先天性甘油三酯水平偏高──比正常值整整超出800毫克/分升，而在这之前的两年，她们长胖了不少。由于担心两姐妹中的任何一个人可能会因为突发心脏病而倒下，她们就读的小学安装了一个自动体外心脏除颤器。

Dr. Urbina prescribes a prescription form of fish oil pills to help reduce triglycerides. Lately, work at portion control and a weekly session with a personal trainer contributed in March to 'the most improvement they've ever shown' during a checkup with Dr. Urbina, their mother, Sally Cassabon, said. Their triglycerides dipped below 200 mg/dL, still short of a goal of below 150 mg/dL, but enough to help them each lose at least 25 pounds.

乌尔比纳以处方药形式开出鱼油药丸用以帮助减少甘油三酯。双胞胎的妈妈萨利•卡萨博(Sally Cassabon)说，最近，孩子们在饮食上的份量控制和每周一次与私人教练的会面使她们在3月份接受乌尔比纳博士检查时“表现出有史以来最明显的改善”。她们的甘油三酯已骤降至200毫克/分升以下，虽然还没有达到低于150毫克/分升的目标值，但足以帮她们减掉25磅（约合11.3公斤）。